Despite positive economic forecasts, stable democracies, and reduced regional conflicts since the turn of the century, Africa continues to be afflicted by poverty, poor infrastructure, and a massive burden of communicable diseases such as HIV, malaria, tuberculosis, and diarrheal illnesses. With the rising prevalence of chronic kidney disease and kidney failure worldwide, these factors continue to hinder the ability to provide kidney care for millions of people on the continent. The International Society of Nephrology Global Kidney Health Atlas project was established to assess the global burden of kidney disease and measure global capacity for kidney replacement therapy (dialysis and kidney transplantation). The aim of this second iteration of the International Society of Nephrology Global Kidney Health Atlas was to evaluate the availability, accessibility, affordability, and quality of kidney care worldwide. We identified several gaps

Thrombotic thrombocytopenic purpura (TTP) is a rare variant of thrombotic microangiopathy. We report a case of TTP in a Nigerian chronic kidney disease (CKD) patient who was previously on clopidogrel. The features of TTP resolved soon after clopidogrel was withdrawn. Clopidogrel is a cardio-protective anti-platelet drug used in CKD patients at risk of dyspepsia. However, its potential to cause TTP should be recognized and considered in acute kidney injury (AKI) patients previously on clopidogrel. Keywords: Clopidogrel; Thrombotic Thrombocytopenic Purpura; CKD; AKI; uremic encephalopathy.

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In AKD group, we had 7 class IV lupus nephritis patients with median SLEDAI score of 16 (IQR, 14-18), nephrotic flare (median 24h proteinuria 3.6g) and 6/7 AKD had infections (4 pulmonary, 2 gastrointestinal) on admission. Their infections were complicated by clinical thrombotic microangiopathy (TMA) (defined as elevated D-Dimer, LDH, hemolytic anemia, schistocytes, thrombocytopenia). 5/6 TMA were proven by kidney biopsy. They were started with broad spectrum antibiotics, heparin, tapered steroid, therapeutic plasma exchange (2/7) or plasma infusion (5/7) and hemodialysis (HD) (as needed). A/H1N1 influenza was diagnosed at the rebound fever with normal white blood count (WBC) after the primary response to antibiotics. In ESRD group, we had 6 patients admitted because of infection which 3/6 pneumonia complicated by acute respiratory failure, 2/6 gastrointestinal and 1/6 skin infection. Overall, symptoms of A/H1N1 Influenza infection were not specific with fever (100%), cough (84.6%), dyspnea (61.5%), rhinorrhea (15.4%), bodyache (15.4%), sorethroat (7.7%), and diarrhea (15.4%). No one received influenza vaccination. Mechanical ventilation was required in 3 ESRD (in which 2 death) and 2 AKD. All were isolated and under multidisciplinary care with oral 7-day oseltamivir. Three months after discharge, 4 ESRD continued HD, 7 AKD reached partial remission of kidney function with (1) 6/6 withdrew HD, (2) 7/7 decreased Scre >50% from peak (Scre of 3.0 mg/dL (IQR, 2.3-5.2) to 1.9 mg/dL (IQR,1.5-2.3 at 3 month).

Portal hypertensive gastropathy (PHG) is a gastric mucosal lesion complicating portal hypertension, with higher prevalence in decompensated cirrhosis. PHG can sometimes complicate autosomal dominant polycystic kidney disease (ADPKD) due to the presence of multiple liver cysts. Besides, PHG is known to present as chest pain, with or without hematemesis. Other causes of chest pain in ADPKD include referred chest pain from progressively enlarging kidney cysts, and rare pericardial cysts. Chest pain, especially if pleuritic, in end-stage renal disease (ESRD) patients, is often ascribed to uremic pericarditis. We present recurrent pleuritic chest pain in a 24-year old ESRD patient with ADPKD that was initially misdiagnosed as uremic pericarditis. It was ultimately shown to represent symptomatic PHG with excellent therapeutic response to proton pump inhibitors.

Hyperkalemia is not uncommon in patients with end-stage renal disease (ESRD) on maintenance hemodialysis, often related to dietary indiscretion, following the prolonged inter-dialytic weekend interval in patients on thrice weekly hemodialysis treatments, and sometimes the adverse effects of medications such as RAAS blocking agents. Moreover, hyperkalemia following extended cardiac surgery can result from the use of high-potassium containing cardioplegic solutions used during cardiopulmonary bypass. Nevertheless, different from the foregoing, in the nephrology literature, there have been very rare reports of potentially life-threatening hyperkalemia following cardiac valve replacement procedure. We recently encountered an unusual case of persistent relapsing hyperkalemia complicating aortic valve replacement (AVR) in a 53-year-old obese Caucasian male patient despite repeated daily intermittent hemodialysis treatments. Our case report is the first to clearly demonstrate the yo-yo recurrence of newly observed episodes of hyperkalemia reappearing despite repeated treatments.